EQUIPMENT
Chest tube tray (generally includes):

Chest tube (size designated by physician)
Trocar
Drainage system
Suture scissors
Hemostats
Needle holder
Syringes
Needles of various sizes
Stopcock
4

× 4 gauze

Medicine cup
Y connector
Forceps
Drapes, towels

Sterile water or saline (1,000 cc bottle)
Local anesthetic
Gloves, sterile
Gown, mask
Stethoscope
Antiseptic (e.g., povidone-iodine)
Alcohol swabs
Petrolatum gauze
Clamp, padded
Adhesive tape
Rubber band and safety pin (optional)
Suture with needle (check if in tray)

PROCEDURE

1. Explain procedure and reason to child and family.

Enhances cooperation and participation and reduces
anxiety and fear.

2. Obtain signed consent.
3. Premedicate as ordered. Decreases discomfort associ-

ated with chest tube insertion.

4. Gather equipment. Promotes organization and effi-

ciency.

5. Wash hands. Reduces transmission of microorganisms.
6. Assist physician in preparing child and necessary sup-

plies. Set up drainage system according to instructions
accompanying the system (see Preparing the Chest
Tube Drainage System).

7. Assist physician as required.
8. Once the tube is in place and connected to the drainage

system, ensure the integrity and functioning of the sys-
tem.
a. Ensure that the water in the suction control cham-

ber/bottles is bubbling gently.

b. Check the water seal for bubbles. Bubbles in the

water seal chamber/bottle indicate air is entering the
system. Potential sources of air include (1) a leak in
the tubing, (2) a leak under the dressing, (3) a leak
from the pleural cavity, (4) drainage of air from the
pleural cavity, and (5) a crack in the unit.

c. Make sure all tubing connections are tight and

wrapped with adhesive tape. Loose connections will
cause an air leak in the system and ineffective
drainage of fluid and air.

d. Secure chest tube drainage tube to gown using the

clamp that comes with the system or a rubber band
and safety pin.

NOTE: Do not pin or secure tubing to the bedding.
Reduces the risk of accidentally dislodging the tube.

NOTE: Policy at some agencies may prohibit the use of
safety pins.

9. Assist in obtaining a chest X ray. Confirms position of

the tube and whether it has begun to evacuate fluid and
air.

10. Monitor vital signs, drainage, and insertion site every 15

minutes for 2 hours or according to agency policy.

DOCUMENTATION

1. Premedication given.
2. Insertion and how tolerated.
3. Size and location of tube.
4. Type of drainage system used.
5. X-ray results.
6. Functioning of drainage system, including if there is

suction and at what pressure.

7. Amount, color, and consistency of drainage.
8. Respiratory status.

88

Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.

SKILL 39

SKILL 39

Assisting with Chest Tube Insertion